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儿童扁桃体切除术中清醒与深麻醉下气道装置拔除的比较：系统评价与荟萃分析

Awake versus deep airway device removal in pediatric tonsillectomy: a systematic review and meta-analysis.

综述 Meta咽喉科IF 2.1Q2

文献信息

PMID42855124
原文在 PubMed 查看原文 ↗
发表日期2026
作者Henrique Baggio Pivetta
查看其他 9 位作者

Alice O Almeida；Rafael L Miranda；Rafaela P Silva；Raphaela G Mendes；João M M Borges；Raquel E Saldanha；Matheus Arraes；Pablo P Sanín；Walid Alrayashi

作者单位Universidade do Sul de Santa Catarina, Department of Medicine, Palhoça, SC, Brazil. Electronic address: henriquebpivetta@hotmail.com.
查看其他 8 条单位信息

Faculdade de Medicina Zarns, Department of Medicine, Salvador, BA, Brazil.；Universidade Federal de Minas Gerais, Department of Medicine, Belo Horizonte, MG, Brazil.；Universidade Federal do Maranhão, Department of Medicine, São Luís, MA, Brazil.；The University of Texas Health Science Center at Houston, Houston, TX, USA.；Hospital Instituto José Frota, Anesthesiology Department, Fortaleza, CE, Brazil.；University of Miami Miller School of Medicine, Miami, FL, USA.；Colsubsidio Cardiovascular Clinic, Bogotá, Colombia.；Boston Children's Hospital and Harvard Medical School, Anesthesiology Department, Critical Care, and Pain Medicine, Boston, Massachusetts, USA.

期刊Brazilian journal of anesthesiology (Elsevier)
SCI 分区Q2
IF2.1
研究类型综述 Meta · 临床
所属专科咽喉科

中文摘要

背景与目的： 扁桃体切除术（伴或不伴腺样体切除术）是儿童最常见的手术之一，与围手术期呼吸不良事件的高发生率相关。气道装置拔除的时机，即在深麻醉期间还是苏醒后拔除，可能影响这些结局。
方法： 系统检索了PubMed、Embase和CENTRAL，以寻找比较儿童耳鼻喉科手术中清醒与深麻醉下气道装置拔除的研究。主要分析仅限于随机对照试验（RCT）。主要结局为喉痉挛；次要结局包括咳嗽、氧饱和度下降和气道梗阻。采用随机效应模型合并风险比（RR）及95%置信区间（95% CI）。
结果： 共分析7项研究（6项RCT和1项观察性研究，后者仅用于敏感性分析），包括1,571名儿童。深麻醉下气道装置拔除与更高的气道梗阻风险相关（RR = 1.82；95% CI 1.10-3.03；p = 0.020），并与更低的咳嗽风险相关（RR = 0.57；95% CI 0.43-0.75；p < 0.001），喉罩（LMA）与气管插管（ETT）亚组之间无差异证据（亚组差异p = 0.992）。喉痉挛无显著差异（RR = 0.99；95% CI 0.43-2.30；p = 0.984）。在仅纳入RCT的分析中，深麻醉下拔除的氧饱和度下降更低（RR = 0.62；95% CI 0.44-0.88；p = 0.007）。
结论： 深麻醉下气道装置拔除与较少的咳嗽相关，且无证据表明该效应在LMA与ETT之间存在差异。深麻醉下拔除可能增加气道梗阻，但该结果对单项研究敏感。氧饱和度下降的发现对研究设计敏感，并非定论。

英文摘要

BACKGROUND AND OBJECTIVES: Tonsillectomy, with or without adenoidectomy, is among the most common pediatric surgeries, associated with a high incidence of perioperative respiratory adverse events. The timing of airway device removal, during deep anesthesia or after awakening, may influence these outcomes.
METHODS: PubMed, Embase and CENTRAL were systematically searched for studies comparing awake and deep airway device removal in pediatric otolaryngology surgery. The primary analysis was restricted to Randomized Controlled Trials (RCTs). The primary outcome was laryngospasm; secondary outcomes included cough, oxygen desaturation and airway obstruction. Risk Ratios (RR) with 95% Confidence Intervals (95% CI) were pooled using random-effects models.
RESULTS: Seven studies (six RCTs and one observational study, the latter used only in sensitivity analyses), including 1,571 children, were analyzed. Deep airway device removal was associated with a higher risk of airway obstruction (RR = 1.82; 95% CI 1.10-3.03; p = 0.020) and a lower risk of cough (RR = 0.57; 95% CI 0.43-0.75; p < 0.001), with no evidence of a difference between the Laryngeal Mask Airway (LMA) and Endotracheal Tube (ETT) subgroups (p for subgroup differences = 0.992). Laryngospasm did not differ significantly (RR = 0.99; 95% CI 0.43-2.30; p = 0.984). Desaturation was lower with deep removal in the RCT-only analysis (RR = 0.62; 95% CI 0.44-0.88; p = 0.007).
CONCLUSIONS: Deep airway device removal was associated with less coughing, with no evidence that this effect differed between LMA and ETT. Deep removal may increase airway obstruction, though sensitive to individual studies. Desaturation findings were sensitive to study design and sare not definitive.